Bed sores: Treatment, stages, and prevention

Bed sores can affect people who spend a long time in one position, for example, because of paralysis, illness, old age, or frailty.

Also known as pressure ulcers and pressure sores, bed sores can happen when there is friction or unrelieved pressure on one part of the body.

People who cannot make even small movements are at risk of pressure sores.

The sores can affect any part of the body, but the bony areas around the elbows, knees, heels, coccyx, and ankles are more susceptible.

Bedsores are treatable, but, if treatment comes too late, they can lead to fatal complications.

The prevalence of pressure sores in intensive care units in the United States (U.S.) is estimated to range from 16.6 percent to 20.7 percent.

Fast facts on pressure sores

Here are some key points about pressure sores. More detail is in the main article.

Pressure sores, pressure ulcers, or bedsores commonly affect people who cannot move easily.

They are more likely to affect the bony parts of the body.

The sores develop in stages. Identifying them in the early stage enables treatment and reduces the risk of complications.

Moving patients frequently is key to preventing pressure sores.

Treatment

[Pressure sores relief]
Placing a pillow under the affected area can help to alleviate pressure and symptoms.

Treating pressure ulcers is not easy.

An open wound is unlikely to heal rapidly. Even when healing does take place, it may be inconsistent, because of the damage to skin and other tissues.

Less severe pressure ulcers often heal within a few weeks with proper treatment, but serious wounds may need surgery.

The following steps should be taken:

Remove the pressure from the sore by moving the patient or using foam pads or pillows to prop up parts of the body.

Clean the wound: Minor wounds may be gently washed with water and a mild soap. Open sores need to be cleaned with a saline solution each time the dressing is changed.

Control incontinence as far as possible.

Remove dead tissue: A wound does not heal well if dead or infected tissue is present, so debridement is necessary.

Apply dressings: These protect the wound and accelerate healing. Some dressings help prevent infection by dissolving dead tissue.

Use oral antibiotics or antibiotic cream: These will can help treat an infection.

In the early stages, people may treat ulcers at home, but more severe ulcers will need dressing by a health care professional.

Negative pressure wound therapy

Also known as vacuum-assisted therapy, this procedure involves the attachment of a suction tube to the bedsore. The tube draws moisture from the ulcer, drastically improving the healing time and reducing the risk of infection.

Wounds heal within around 6 weeks at half the cost of surgery.

[Pressure sores]
There are varying stages of severity of pressure sore.

Pressure sores develop in four stages.

The skin will look red and feel warm to the touch. It may be itchy.

There may be a painful open sore or a blister, with discolored skin around it.

A crater-like appearance develops, due to tissue damage below the skin’s surface.

Severe damage to skin and tissue, possibly with infection. Muscles, bones, and tendons may be visible.

An infected sore takes longer to heal, and the infection can spread elsewhere in the body.

Pictures

Warning: The following images are graphic:

Early-stage, necrotic pressure sore

necrose pressure sore
Image credit: Dr. Andrea Settje, SKM-Hospital, Nepal, 2005

Early-stage pressure sore

Early pressure sore
Image credit: AfroBrazilian, 2014

Stage 4 pressure sore

stage 4 pressure ulcer
Image credit: Noles1984, 2008

Severe pressure sore

Severe pressure sore
Image credit: AfroBrazilian, 2016

Prevention

Even with excellent medical and nursing care, bedsores can be hard to prevent, especially among vulnerable patients.

Preventing bedsores is easier than treating them, but this too can be challenging.

Tips to reduce the risk of a bed sore developing include:

moving the patient at least every 15 minutes for wheelchair users and at every 2 hours for people in bed

daily skin inspections

keeping the skin healthy and dry

maintaining good nutrition, to enhance overall health and wound healing

quitting smoking

exercises, even if they must be carried out in bed, with assistance, as they improve circulation.

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